Differences in pain regimens among nulliparous patients undergoing intrauterine device placement within a single health system - 11/04/25

Doi : 10.1016/j.ajog.2025.03.021

Danielle G. Tsevat, MD ^a,^b,^⁎ , Vanessa Miller, MPH, PhD ^b, Mia Hodges, BS ^c, Celia Mizelle, MD ^d, Julia Kessel, BS ^c, Gretchen Sauer, MD, MPHTM ^a, Kavita S. Arora, MD, MBE, MS ^a, James H. Allison, MD ^e, Bianca A. Allison, MD, MPH ^f
^a Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC
^b Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
^c University of North Carolina School of Medicine, Chapel Hill, NC
^d Department of Pediatrics, University of Colorado, Aurora, CO
^e Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
^f Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC

^∗Corresponding author: Danielle G. Tsevat, MD.

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Abstract

Background

Although offering pain management with intrauterine device placement is recommended, but no standardized protocol exists. Patients may experience disparities pain regimens offered with placement based on where they seek care.

Objective

This study aimed to describe the pain medication regimens that clinicians use for intrauterine device placement and the patient and clinician factors and clinic settings associated with receiving medication before and during placement.

Study Design

We performed a retrospective study of nulliparous individuals aged 15 to 50 years who had an intrauterine device placed from 2019 to 2021 (N=1153) across a large statewide health system in the Southeast. From the electronic health record, we abstracted exposure variables (ie, patient, clinician, and clinic characteristics) and outcomes (ie, medication regimens used before and during intrauterine device placement). We used bivariate analysis and multivariable logistic regression to examine associations between exposure variables and outcomes.

Results

Less than half of the patients (41.7%) received medications before or during intrauterine device placement. Medication regimens used before and during intrauterine device placement varied by clinician specialty, clinician type, and clinic location. After multivariable regression, patients were more likely to receive preinsertion medications if they had a lower body mass index, received the Skyla intrauterine device, were treated by advanced practice providers or clinicians with a specialty in pediatrics or internal medicine, or were seen in >1 clinic visit for their intrauterine device placement (all P<.01). Patients were more likely to receive pain medications during intrauterine device placement if they were younger, treated by internal medicine clinicians, or had their intrauterine device placed on the same day they requested it, and they were less likely to receive medications during placement if seen by advanced practice providers or in a rural setting (all P<.01). There were no differences by patient race or insurance type.

Conclusion

We found that pain management with intrauterine device placement is associated with clinician specialty, clinician type, and practice setting, with few significant patient factors. Although no particular pain regimen is universally recommended, several options have been shown to be potentially beneficial for nulliparous patients. Therefore, improving clinician knowledge about effective pain regimens and expanding resources across all clinic settings may improve nulliparous patients’ experiences and shared decision-making regarding medication use before and during intrauterine device placement.

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Key words : disparities, intrauterine device, pain control

Plan

Introduction

Materials and methods

Results

Pain medication administered by clinician specialty and type

Pain medication use by clinic location

Pain medication use by patient characteristics

Comment

Principal findings

Results in the context of what is known

Clinical implications

Research implications

Strengths and limitations

Conclusion

CRediT authorship contribution statement

This project was supported by (1) a research grant from the Investigator-Initiated Studies Program of Organon (MISP 60724) and (2) the Clinical and Translational Science Awards Program of the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH) (UL1TR002489). B.A.A. was partially supported by NCATS, NIH (grant number 1K12TR004416-01). The opinions expressed in this publication are those of the authors and do not necessarily represent those of Organon or NIH. Organon had access to the manuscript before submission, but the authors retain all scientific decision-making regarding all aspects of the work, including the study design, data collection, analyses, interpretation of findings, writing of the report, or the decision to submit the manuscript for publication. NIH had no part in the study design, data collection, analyses, interpretation of findings, writing of the report, or the decision to submit the manuscript for publication.

Cite this article as: Tsevat DG, Miller V, Hodges M, et al. Differences in pain regimens among nulliparous patients undergoing intrauterine device placement within a single health system. Am J Obstet Gynecol 2025;XX:x.ex–x.ex.